髋部前方小切口复位经皮空心钉内固定治疗股骨颈骨折的临床研究

Clinical Research of the Effect of Reduction via Small Incision on the Anterior of the Hip and Percutaneous Internal Fixation with Cannulated Screws in the Treatment of Femoral Neck Fracture

目的探讨前方微创小切口复位经皮空心钉内固定治疗GardenⅢ、IV型股骨颈骨折的治疗效果。方法从2012年1月—2013年4月整群选取应用空心钉内固定治疗GardenⅢ、IV型股骨颈骨折72例,按治疗方法不同分为两组：其中观察组38例：采用微创切口,直视下复位骨折,经皮空心钉内固定。对照组34例：采用传统外侧切口,切开复位空心钉内固定。结果术后随访12-18个月,骨折愈合率：观察组：98%,对照组：90%：;股骨头坏死率：观察组：1%,对照组：5%;优良率：观察组：92.1%,对照组：64.7%,差异有统计学意义（P〈0.05）。结论经前方微创小切口复位经皮空心钉内固定术,可在直视下保证复位的确切性;并最大限度减少损伤髋关节周围的血管网。为骨折愈合创造有利条件。具有出血少,操作时间短等优点。较传统切口有明显优势。

Objective To study the treatment effect of Garden III and IV femoral neck fractures treated by reduction via minimally invasive incision on the anterior of the hip and percutaneous internal fixation with cannulated screws. Methods72 cases with Garden III and IV femoral neck fractures treated by internal fixation with cannulated screws from January2012 to April 2013 were selected and divided into two groups, the observation group（38 cases） and the control group（34cases） in accordance with the treatment method. Patients in the observation group were treated by reduction via minimally invasive incision under direct vision and percutaneous internal fixation with cannulated screws. And those in the control group were treated by open reduction via the traditional lateral incision and internal fixation with cannulated screws. Results The patients were followed up for 12-18 months after surgery. The results of treatment showed that there were statistically significant differences between the observation group and the control group in the fracture healing rate（98% vs 90%）,femoral head necrosis rate（1% vs 5%）, and the excellent and good rate of treatment effect（92.1% vs 64.7%）（P〈0.05）.Conclusion Reduction via minimally invasive incision on the anterior of the hip and percutaneous internal fixation with cannulated screws have much better effect than the surgery with traditional incision with less bleeding and shorter duration of procedure, which can guarantee the accuracy of the reduction under direct vision and reduce the injury of vascular network around the hip joint to the utmost extent, and is conducive to the fracture healing.